DEPARTMENT OF PUBLIC SAFETY
LICENSE SECTION
COMMERCIAL SALES PROMOTER
FORM W-2, WAGE AND TAX STATEMENT
AFFIDAVIT
Per the Internal Revenue Service (IRS),
“Every employer engaged in a trade or business who pays remuneration,
including noncash payments of $600 or more for the year (all amounts if any income, social security, or
Medicare tax was withheld) for services performed by an employee must file a Form W-2 for each employee.”
I, ____________________________, representative of, ________________________
that by signing below, I must provide the City of Columbus, License Section with a list of current, and future
Form W-2 employees prior to the issuance of a Commercial Sales Promoters license, or Commercial Sales license
associated with said business.
I understand and certify that these statements are accurate and true. I also
acknowledge the information
contained herein may subject me to certain penalties, under Columbus City Code 523.08 (b)(1), which include,
but are not limited to, suspension, revocation or permanent revocation of the Commercial Sales Promoter
license being applied for.
State of Ohio, County of Franklin
Representative’s Name: _____________________________________
Please Print
Representative’s Signature: __________________________________
Please Sign
Sworn to before me and subscribed in my presence this _______ day of __________________, 20 _______.
_________________________________________________
Officer or Agent of the Director of Public Safety
